Michael Douglas: oral sex caused my cancer
Actor reveals to the Guardian that HPV, transmitted through oral sex, was responsible for his throat cancer
Catherine Shoard
The Guardian, Sunday 2 June 2013
Michael Douglas: 'There was a walnut-size tumour at the base of my tongue that no other doctor had seen.' Photograph: APImages/ALIVEpress/CorbisMichael Douglas – the star of Basic Instinct and Fatal Attraction – has revealed that his throat cancer was apparently caused by performing oral sex.
In a surprisingly frank interview with the Guardian, the actor, now winning plaudits in the Liberace biopic Behind the Candelabra, explained the background to a condition that was thought to be nearly fatal when diagnosed three years ago. Asked whether he now regretted his years of smoking and drinking, usually thought to be the cause of the disease, Douglas replied: "No. Because without wanting to get too specific, this particular cancer is caused by HPV [human papillomavirus], which actually comes about from cunnilingus."
Douglas, the husband of Catherine Zeta Jones, continued: "I did worry if the stress caused by my son's incarceration didn't help trigger it. But yeah, it's a sexually transmitted disease that causes cancer. And if you have it, cunnilingus is also the best cure for it."
The actor, now 68, was diagnosed with cancer in August 2010, following many months of oral discomfort. But a series of specialists missed the tumour and instead prescribed antibiotics. Douglas then went to see a friend's doctor in Montreal who looked inside his mouth using a tongue depressor.
"I will always remember the look on his face," Douglas has previously said. "He said: 'We need a biopsy.' There was a walnut-size tumour at the base of my tongue that no other doctor had seen."
Shortly afterwards he was diagnosed with stage four cancer, which is often terminal, and embarked on an intensive eight-week course of chemotherapy and radiation. He refused to use a feeding tube, despite his palate being burnt on account of the treatment, and so lost 20kg (45lb) on a liquids-only diet. "That's a rough ride. That can really take it out of you," he told the Guardian. "Plus the amount of chemo I was getting, it zaps all the good stuff too. It made me very weak."
The treatment worked and Douglas is now more than two years clear of cancer. He has check-ups every six months, he said, "and with this kind of cancer, 95% of the time it doesn't come back".
The cause of Douglas's cancer had long been assumed to be related to his tobacco habit, coupled with enthusiastic boozing. In 1992, he was hospitalised for an addiction which some at the time claimed to be sex. Douglas himself denied this and said he was in rehab for alcohol abuse. He has also spoken of recreational drug use.
HPV, the sexually transmitted virus best known as a cause of cervical and anal cancer and genital warts, is thought to be responsible for an increasing proportion of oral cancers.
Some suggest that changes in sexual behaviour – a rise in oral sex in particular – are responsible. Such changes might be cultural, but could also be linked to fears about the safety of penetrative sex in the wake of the Aids epidemic.
Mahesh Kumar, a consultant head and neck surgeon in London, confirmed that the last decade has seen a dramatic rise in this form of cancer, particularly among younger sufferers. Recent studies of 1,316 patients with oral cancer found that 57% of them were HPV-16 positive.
"It has been established beyond reasonable doubt that the HPV type 16 is the causative agent in oropharyngeal cancer," said Kumar, who also testified to increased recovery rates among this kind of cancer sufferer. This would help explain why Douglas was given an 80% chance of survival, despite the advanced stage of his illness.
But Kumar expressed scepticism that Douglas's cancer was caused solely by HPV, and surprise at Douglas's assertion that cunnilingus could also help cure the condition. "Maybe he thinks that more exposure to the virus will boost his immune system. But medically, that just doesn't make sense."
Ann Robinson, a GP, expressed interest in how confirmation of this association would affect the rollout of the HPV vaccine, which is currently restricted in the UK. "My main priority with diagnosing a patient with oral cancer is to get them referred, as early intervention can be so crucial. Asking for a detailed sexual history would be inappropriate at that stage."
Douglas has two children, aged 10 and 12, with his second wife, Zeta Jones, as well as an older son, Cameron, from a previous marriage. In 2010, Cameron was sentenced to five years in prison for drugs possession and dealing, and a year later had his sentence extended until 2018 after he pleaded guilty to possessing drugs in prison.HPV: the facts
- There are more than 100 variants of HPV (human papillomavirus). They appear in different parts of the body and manifest themselves in different ways – some cause warts, but most are symptomless.
- Some are spread by skin-to-skin contact, while others are typically spread during sex. When HPV is found in the mouth, it probably got there as a result of oral sex.
- HPV is common – if you're a sexually active adult, you've probably had it. By the age of 25, 90% of sexually active people will have been exposed to some form of genital HPV.
- Around 15 types of HPV are linked to increased cancer risk, but it can't be explicitly said to cause any particular cancers. It's a long-term risk factor: over years and decades the risk is increased, rather than overnight.
- It is calculated that between 25% and 35% of oral cancers are HPV-related – meaning that it seems to be involved in 1,500-2,000 diagnoses a year.
- Overall, HPV-related oral cancers are most common in heterosexual men in their 40s and 50s.
- Teenage girls in the UK and elsewhere are now vaccinated against HPV, which should in time both protect them from cervical cancers and – it's believed – future partners from HPV-related oral cancers.
Read Xan Brooks' full interview with Michael Douglas
Here is some more information:
Michael Douglas says cunnilingus gives you cancer – but is he right?
Michael Douglas, who was diagnosed with throat cancer in 2010, says oral sex was the cause. But what's the risk?
James Ball
guardian.co.uk, Sunday 2 June 2013
Michael Douglas Photograph: AAPimages/ALIVEpress/ AAPimages/ALIVEpress/dpa/Corbi
Actors are often accused of being irritatingly reticent about their private lives – unwilling to satisfy fans' and journalists' curiosity about aspects of their life off the film sets.
But that's not something that can be said of Michael Douglas' latest interview, with Xan Brooks, for the Guardian. Asked whether he ascribed his 2010 throat cancer diagnosis to a lifetime of drinking and smoking, he replied particularly frankly:
"No. Because without wanting to get too specific, this particular cancer is caused by HPV [human papillomavirus], which actually comes about from cunnilingus."
"I did worry if the stress caused by my son's incarceration didn't help trigger it. But yeah, it's a sexually transmitted disease that causes cancer. And if you have it, cunnilingus is also the best cure for it."
So, now that's out there, how much of it is true? Is oral sex linked to mouth and throat cancers? Is there a difference between the genders? And what can be done? We've dug into the stats – especially this NHS guide – to dig out a few answers.
HPV and you
There are more than 100 variants of HPV, otherwise known as the human papilloma virus, and they appear in different parts of the body and manifest in different ways – some, for example, can cause warts (including genital warts), while in most cases most appear symptomless.
Some are spread simply by skin-to-skin contact, while others are typically spread during sex. It's these latter types that are typically found in the mouth, suggesting that when HPV is found in the mouth, it's probably got there as a result of oral sex. HPV can also be spread to the relevant areas through vaginal and anal sex.
HPV is really, really common – to the point that if you're a sexually active adult, you've probably had it. By the age of 25, 90% of sexually active people will have been exposed to some form of genital HPV (whether high or low risk), almost none of whom will ever have had any visible warts or other symptoms.
HPV and cancer
Around 15 types of HPV are linked to increased cancer risk, and it's been associated with oral cancers, cervical and vaginal cancers, as well as anal and penile cancers.
Around 15 types of HPV are linked to increased cancer risk, and it's been associated with oral cancers, cervical and vaginal cancers, as well as anal and penile cancers.
HPV increases cancer risk, but can't be explictly said to have caused any particular cancers (though some variants are HPV-related and others not): just because someone with cancer also has HPV doesn't necessarily mean they wouldn't have got it anyway.
It's also a long-term risk factor: over years and decades the risk is increased, rather than overnight.
When it comes to oral cancers, here's a rough guide to the statistics. In 2010, around 6,000 people were diagnosed. For comparison, in 2010 there were also 2,850 diagnoses of cervical cancer and 49,900 diagnoses of breast cancer.
Noting the above caveats, it's calculated that between 25% and 35% of oral cancers are HPV-related – meaning it seems to be involved in somewhere between 1,500 to 2,000 diagnoses a year.
HPV increases cancer risk, but can't be explictly said to have caused any particular cancers (though some variants are HPV-related and others not): just because someone with cancer also has HPV doesn't necessarily mean they wouldn't have got it anyway.
It's also a long-term risk factor: over years and decades the risk is increased, rather than overnight.
When it comes to oral cancers, here's a rough guide to the statistics. In 2010, around 6,000 people were diagnosed. For comparison, in 2010 there were also 2,850 diagnoses of cervical cancer and 49,900 diagnoses of breast cancer.
Noting the above caveats, it's calculated that between 25% and 35% of oral cancers are HPV-related – meaning it seems to be involved in somewhere between 1,500 to 2,000 diagnoses a year.
Men vs women
So – is cunnilingus inherently riskier than fellatio? While studies on sex differences aren't entirely clear, a US study found the prevalence of HPV in the mouths of men was 10%, versus 3.6% for women. Overall, HPV-related oral cancers are most common in heterosexual men in their 40s and 50s, leading the NHS guide to conclude that:
This indicates that performing cunnilingus (oral sex on a woman) is more risky that performing fellatio (oral sex on a man). This seems counterintuitive, but the concentration of HPV in the thinner moist skin of the vulva is mugh higher than the amounts of virus shed from the thicker dry skin of the penis, and this affects how easy it is to pass the virus on.
The HPV vaccine
Teenage girls in the UK and elsewhere are now vaccinated against HPV, which should in time both protect themselves from cervical cancers and – it's believed but not yet been demonstrated – future partners from HPV-related oral cancers.
Evidence from Australia suggests things are working, with genital warts (a good short-term proxy) falling markedly in women and heterosexual men in the years after the introduction of a vaccine.
The one group the current vaccination programme does nothing to protect, of course, is men who have sex with men – who are at increased risk of several cancers due to HPV.
So ... smoking's exonerated?
Douglas used HPV to exonerate smoking for his particular cancer. Unfortunately, the evidence suggests he wasn't quite right to do so. Most people rid themselves of HPV within a few years of catching it – but smoking disrupts this process, meaning the virus remains for far longer in smokers than non-smokers, increasing their risk of HPV-related cancers of all varieties.
Smoking is also, of course, a substantial risk factor for non HPV-related oral cancers, as well as lung cancer.
Staying safe
Unfortunately, there doesn't seem to be much research evidence to back up Douglas' claim that the cure for throat cancer is still more cunnilingus.
One thing that can help, though, is using a condom or a dam during oral sex, the NHS says. It also helps protect against other orally-transmitted STDs too, such as chlamydia and gonorrhoea.
Any other studies or evidence we should've looked at? Anyone got some other good stats on the topic? Let us know below...
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